Reduced Carbohydrate Versus Fat in Obese Subjects

Selective Reduction of Dietary Carbohydrate Versus Fat: Effects on Metabolism, Endocrine Physiology, Brain Activity and Reward Circuitry

Popular weight loss strategies often involve reducing an individual's consumption of carbohydrates or fat. However, no controlled study has been carried out to evaluate the effects of reducing carbohydrate versus fat consumption while keeping the other nutrients at standard levels to maintain an individual's weight. Researchers are interested in investigating how different restrictions of carbohydrates or fats affect the many processes involved in weight loss, including brain activity and blood and brain chemical composition.

Study Overview

• Status: Completed
• Conditions: Obesity
• Intervention / Treatment: Other: Reduced fat diet; Other: Reduced carbohydrate diet; Drug: Drug: f-18 fallypride; Device: fMRI; Device: PET

Detailed Description

Popular weight loss strategies often prescribe a targeted reduction of dietary carbohydrate or fat. But surprisingly, no controlled human feeding study has ever investigated the effects of a selective reduction of dietary carbohydrate versus fat while keeping the other dietary macronutrients at their baseline weight-maintenance values. The present study was designed to address this knowledge gap and improve our understanding of how selective reduction of dietary fat versus carbohydrate may differentially impact the many feedback control processes that act to resist weight loss.

Objectives:

- To determine the comparative effects of two controlled fat- or carbohydrate-restricted diets and an outpatient weight loss program on blood and brain chemical composition, weight loss (fat and lean body mass), and regional brain activity in lean and obese individuals.

Eligibility:

- Healthy individuals between 18 and 45 years of age who are either lean (body mass index between 18.5 kg/m(2) and 25 kg/m(2)) or obese (body mass index above 30.0 kg/m(2), weight less than 350 pounds) and are right-handed.

Design:

• Lean participants: Participants will be screened with a medical history, physical examination, blood and urine tests, and weight maintenance observations (food diaries and physical activity monitors). For the scanning visit, participants will receive balanced meals from the National Institutes of Health to consume for 2 days before the visit. During the scanning visit, participants will continue to eat the weight maintenance diet, complete questionnaires, and have a series of imaging studies (including positron emission tomography and magnetic resonance imaging tests) to evaluate brain response to food and other stimuli.
• Obese participants: Participants will be screened with a medical history, physical examination, blood and urine tests, and weight maintenance observations (food diaries and physical activity monitors). During the first inpatient visit, obese participants will eat a weight-maintenance diet for 5 days to establish baseline measurements. After several days of eating a weight-maintenance diet, 20 obese adult volunteers (BMI above 30 kg/m2) will be admitted to the metabolic clinical research unit (MCRU) and, after 5 additional days of the baseline diet, their diets will be modified to result in either 85% reduction of the baseline dietary fat or a 60% reduction of the baseline dietary carbohydrate for the next 6 days. These diet modifications produce an equivalent caloric reduction. The primary outcome measurements will be changes of metabolism, brain reward circuitry and regional brain activity in response to food stimuli measured during the baseline and reduced calorie diet phases. Immediately following each controlled diet, we will measure 3 days of ad-libitum food intake using a computerized vending machine system. The subjects will return to the MCRU after a 2-10 week washout period to receive the opposite reduced calorie diet. Twenty control subjects with normal body weight (BMI between 18.5 - 25 kg/m2) will have measurements of brain reward circuitry and regional brain activity in response to food stimuli while on a balanced, weight-maintenance diet. Immediately following the second in-patient visit, all of the obese subjects will be assigned to a 12 week out-patient weight loss program with the goal of achieving at least 5% weight loss. We will investigate the relationship between short-term fat imbalances measured during the in-patient phases, and the body weight and fat changes during the weight loss program. We will evaluate the effects of weight loss on metabolism, brain reward circuitry, and regional brain activity in response to food stimuli. Finally, if the subjects are available for long-term follow-up, then we will investigate their metabolic phenotype, brain reward circuitry, and regional brain activity in response to food stimuli yearly over the subsequent 5 years following the weight loss intervention. This study will result in an improved understanding of the physiological mechanisms that sense and respond to negative energy balance acutely, after several weeks, and after several years, and may eventually lead to increased long-term success of obesity treatment.

• Study Type: Interventional
• Enrollment (Actual): 43
• Phase: Phase 2

Contacts and Locations

Study Locations

• United States
  • Maryland
    • Bethesda, Maryland, United States, 20892
      • National Institutes of Health Clinical Center, 9000 Rockville Pike

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 45 years (Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

• INCLUSION CRITERIA:
• Age 18-45 years, male or female
• Body mass less than 350 lbs. (max. weight dictated by table limit for functional magnetic resonance imaging (fMRI) scanner) when acquisition of large bore fMRI is complete, max. wt. limit will increase to 400 lbs.
• Weight stable (less than plus or minus 5 kg over past 6 months)
• Body mass index greater than or equal to 30.0 kg/m(2)
• Premenopausal (women only)
• Healthy, as determined by medical history and laboratory tests
• Able to complete daily bouts of walking at a moderate rate
• Written informed consent

EXCLUSION CRITERIA:

• Body mass greater than 350 lbs. (max. weight dictated by table limit for fMRI scanner) when acquisition of large bore fMRI is complete, max. wt. limit will increase to 400 lbs.
• BMI less than 30.0 kg/m(2)
• Evidence of metabolic or cardiovascular disease, or disease that may influence metabolism (e.g. cancer, diabetes, thyroid disease)
• Taking any prescription medication (except birth control) or other drug that may influence metabolism (e.g. diet/weight-loss medication)
• Hematocrit less than 34% (women only)
• Hematocrit less than 40% (men only)
• Pregnancy, lactation (women only)
• Allergy to lidocaine or ethanol
• Participating in a regular exercise program (greater than 2h/week of vigorous activity)
• Caffeine consumption greater than 150 mg/day (will be clamped at baseline intake during study)
• Regular use of alcohol (greater than 2 drinks per day), tobacco (smoking or chewing), amphetamines, cocaine, heroin, or marijuana over past 6 months
• Past or present history of eating disorder (including binge eating) or psychiatric disease
• Volunteers with strict dietary concerns (e.g. vegetarian or kosher diet, multiple food allergies)
• Are claustrophobic to a degree that they would feel uncomfortable in the MRI machine.
• Having any metal in their body (for example, pacemakers, metallic prostheses such as cochlear implants or heart valves, shrapnel fragments, etc.).
• Left-handedness
• Non-native English speakers
• Volunteers unwilling or unable to give informed consent

Control Subjects

INCLUSION CRITERIA:

• Age 18-45 years, male or female
• 18.5 kg/m(2) less than BMI less than 25.0 kg/m(2)
• Weight stable (less than plus or minus 5 kg over past 6 months)
• Premenopausal (women only)
• Healthy, as determined by medical history and laboratory tests
• Written informed consent

EXCLUSION CRITERIA:

• BMI less than 18.5 or greater than 25.0 kg/m(2)
• Evidence of metabolic or cardiovascular disease, or disease that may influence metabolism (e.g. cancer or diabetes)
• Taking any prescription medication (except birth control) or other drug that may influence metabolism (e.g. diet/weight-loss medication)
• Hyperlipidemia (fasting plasma triglyceride concentration greater than 150 mg/dl)
• Hematocrit less than 34% (women only)
• Hematocrit less than 40% (men only)
• Pregnancy, lactation (women only)
• Participating in a regular exercise program (greater than 2h/week of vigorous activity)
• Caffeine consumption greater than 150 mg/day
• Regular use of alcohol (greater than 2 drinks per day), tobacco (smoking or chewing), amphetamines, cocaine, heroin, or marijuana over the past 6 months
• Past or present history of eating disorder (including binge eating) or psychiatric disease
• Volunteers with strict dietary concerns (e.g vegetarian or kosher diet, multiple food allergies)
• Are claustrophobic to a degree that they would feel uncomfortable in the MRI machine.
• Having any metal in their body (for example, pacemakers, metallic prostheses such as cochlear implants or heart valves, shrapnel fragments, etc.).
• Left-handedness
• Non-native English speakers
• Volunteers unwilling or unable to give informed consent

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Crossover Assignment
• Masking: None (Open Label)

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Obese RF then RC; Obese adult volunteers (BMI above 30 kg/m2) randomized to receive an 85% reduction of baseline dietary fat (RF) for 2 weeks. After a washout period of 2 weeks, they then received a 60% reduction of baseline dietary carbohydrate (RC) for 2 weeks	Other: Reduced fat diet; RF (selective reduction of 85% of baseline fat calories per day); Other: Reduced carbohydrate diet; RC (selective reduction of 60% of baseline carbohydrate calories per day); Drug: Drug: f-18 fallypride; Dopamine D2 receptor availability is measured by positron emission tomography (PET) using the positron emitting compound [18F] fallypride which binds competitively with dopamine to the D2 receptor.; Device: fMRI; Functional MRI (fMRI) will be used to measure the effects of diet and weight loss on regional brain activity; Other Names: Functional MRI; Device: PET; Positron emission tomography (PET) will be used to assess whether To assess whether brain activity and reward pathways are altered; Other Names: Positron emission tomography
Experimental: Obese RC then RF; Obese adult volunteers (BMI above 30 kg/m2) randomized to receive a 60% reduction of baseline dietary carbohydrate (RC) for 2 weeks. After a washout period of 2 weeks, they then received an 85% reduction of baseline dietary fat (RF) for 2 weeks.	Other: Reduced fat diet; RF (selective reduction of 85% of baseline fat calories per day); Other: Reduced carbohydrate diet; RC (selective reduction of 60% of baseline carbohydrate calories per day); Drug: Drug: f-18 fallypride; Dopamine D2 receptor availability is measured by positron emission tomography (PET) using the positron emitting compound [18F] fallypride which binds competitively with dopamine to the D2 receptor.; Device: fMRI; Functional MRI (fMRI) will be used to measure the effects of diet and weight loss on regional brain activity; Other Names: Functional MRI; Device: PET; Positron emission tomography (PET) will be used to assess whether To assess whether brain activity and reward pathways are altered; Other Names: Positron emission tomography
Active Comparator: Lean Control; Lean adult volunteers (BMI below 30kg/m2) placed on a weight-maintenance diet using a standard diet composition of 50% carbohydrate, 35% fat, and 15% protein on an out-patient basis	Drug: Drug: f-18 fallypride; Dopamine D2 receptor availability is measured by positron emission tomography (PET) using the positron emitting compound [18F] fallypride which binds competitively with dopamine to the D2 receptor.; Device: fMRI; Functional MRI (fMRI) will be used to measure the effects of diet and weight loss on regional brain activity; Other Names: Functional MRI; Device: PET; Positron emission tomography (PET) will be used to assess whether To assess whether brain activity and reward pathways are altered; Other Names: Positron emission tomography

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Respiratory Quotient (RQ)	Respiratory quotient was calculated as the ratio of carbon dioxide production to oxygen consumption as measured in a metabolic chamber for at least 23 continuous hours on days 2 and 5 of the baseline diet and days 1, 4, and 6 of the reduced-energy diets.	Baseline and day 14

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in 24 Hour Energy Expenditure	24 hour energy expenditure was measured in a respiratory chamber.	Baseline and 14 days
Change in Cumulative Fat Imbalance	Measured as the difference between dietary fat intake and fat oxidation by the body as measured in the respiratory chamber	Baseline and 14 days
Caudate Dopamine D2-like Receptor Binding Potential (D2BP)	The time-activity curves for [18F]fallypride tracer concentration in the ROIs were measured by PET and kinetic parameters were fit to a four compartment mathematical model (with the cerebellum used as the reference tissue). D2BP was expressed as the dimensionless ratio of rate constants quantifying binding and unbinding of tracer in the regions of interest.	Day 2 of in-patient admission
Putamen Dopamine D2-like Receptor Binding Potential (D2BP)	The time-activity curves for [18F]fallypride tracer concentration in the ROIs were measured by PET and kinetic parameters were fit to a four compartment mathematical model (with the cerebellum used as the reference tissue). D2BP was expressed as the dimensionless ratio of rate constants quantifying binding and unbinding of tracer in the regions of interest.	Day 2 of in-patient admission
Accumbens Dopamine D2-like Receptor Binding Potential (D2BP)	The time-activity curves for [18F]fallypride tracer concentration in the ROIs were measured by PET and kinetic parameters were fit to a four compartment mathematical model (with the cerebellum used as the reference tissue). D2BP was expressed as the dimensionless ratio of rate constants quantifying binding and unbinding of tracer in the regions of interest.	Day 2 of in-patient admission

Collaborators and Investigators

• Sponsor: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

Publications and helpful links

General Publications

• Must A, Spadano J, Coakley EH, Field AE, Colditz G, Dietz WH. The disease burden associated with overweight and obesity. JAMA. 1999 Oct 27;282(16):1523-9. doi: 10.1001/jama.282.16.1523.
• Samaha FF, Iqbal N, Seshadri P, Chicano KL, Daily DA, McGrory J, Williams T, Williams M, Gracely EJ, Stern L. A low-carbohydrate as compared with a low-fat diet in severe obesity. N Engl J Med. 2003 May 22;348(21):2074-81. doi: 10.1056/NEJMoa022637.
• Allison DB, Zannolli R, Narayan KM. The direct health care costs of obesity in the United States. Am J Public Health. 1999 Aug;89(8):1194-9. doi: 10.2105/ajph.89.8.1194.
• Hall KD, Bemis T, Brychta R, Chen KY, Courville A, Crayner EJ, Goodwin S, Guo J, Howard L, Knuth ND, Miller BV 3rd, Prado CM, Siervo M, Skarulis MC, Walter M, Walter PJ, Yannai L. Calorie for Calorie, Dietary Fat Restriction Results in More Body Fat Loss than Carbohydrate Restriction in People with Obesity. Cell Metab. 2015 Sep 1;22(3):427-36. doi: 10.1016/j.cmet.2015.07.021. Epub 2015 Aug 13.
• Guo J, Simmons WK, Herscovitch P, Martin A, Hall KD. Striatal dopamine D2-like receptor correlation patterns with human obesity and opportunistic eating behavior. Mol Psychiatry. 2014 Oct;19(10):1078-84. doi: 10.1038/mp.2014.102. Epub 2014 Sep 9. Erratum In: Mol Psychiatry. 2022 Oct;27(10):4369.
• Simmons WK, Rapuano KM, Ingeholm JE, Avery J, Kallman S, Hall KD, Martin A. The ventral pallidum and orbitofrontal cortex support food pleasantness inferences. Brain Struct Funct. 2014 Mar;219(2):473-83. doi: 10.1007/s00429-013-0511-0. Epub 2013 Feb 9.
• Simmons WK, Rapuano KM, Kallman SJ, Ingeholm JE, Miller B, Gotts SJ, Avery JA, Hall KD, Martin A. Category-specific integration of homeostatic signals in caudal but not rostral human insula. Nat Neurosci. 2013 Nov;16(11):1551-2. doi: 10.1038/nn.3535. Epub 2013 Sep 29.

Helpful Links

• NIH Clinical Center Detailed Web Page

Study record dates

Study Major Dates

• Study Start: February 13, 2009
• Primary Completion (Actual): February 24, 2014
• Study Completion (Actual): October 20, 2014

Study Registration Dates

• First Submitted: February 14, 2009
• First Submitted That Met QC Criteria: February 14, 2009
• First Posted (Estimate): February 18, 2009

Study Record Updates

• Last Update Posted (Actual): April 15, 2021
• Last Update Submitted That Met QC Criteria: March 24, 2021
• Last Verified: January 22, 2020

More Information

Terms related to this study

• Keywords: Obesity; Healthy Volunteer; Weight Loss; Fat; Carbohydrate; Macronutrient Balance
• Additional Relevant MeSH Terms: Overnutrition; Nutrition Disorders; Overweight; Body Weight; Obesity; Physiological Effects of Drugs; Neurotransmitter Agents; Molecular Mechanisms of Pharmacological Action; Dopamine Agents; Dopamine D2 Receptor Antagonists; Dopamine Antagonists; Fallypride
• Other Study ID Numbers: 090081; 09-DK-0081 (Other Identifier: NIDDK/NIH)

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: Yes
• Studies a U.S. FDA-regulated device product: Yes